TORONTO -- In order to convince everyone in racialized communities to get the COVID-19 vaccine, experts are warning officials not to ignore the racist elephant in the room anymore.
High-profile racist incidents and damning reports involving racialized patients have deepened mistrust for some in Black, Indigenous and communities of colour, experts told CTVNews.ca. And this in part, has led to vaccine hesitancy -- defined by the World Health Organization as people purposely delaying receiving available vaccines.
To get ahead of this, experts are urging federal and provincial public health officials to better target messaging and approach to specific groups (including those with disabilities) because they said the approach right now isn't cutting it.
“It’s quite sad and unfortunate,” Dr. Sajjad Fazel, a public health researcher at the University of Calgary, told CTVNews.ca on Tuesday. “And that’s why you have this gap (in vaccine confidence).”
Front-line workers, including health-care and factory workers, face greater risk of contracting COVID-19. In Canada, many of them are racialized.
But despite the risk, a U.S. survey from the COVID Collaborative, a coalition of national experts on health, education and the economy, found higher levels of vaccine hesitancy and distrust in Black and Latinx populations, compared to their white counterparts.
For some racialized people, Fazel explained, vaccine hesitancy is based on specific concerns and histories. But that’s not uniformly the case. For example, he noted racialized workers in long-term care or hospitals -- with high scientific literacy -- want to do their job safely and are now some of the first Canadians being vaccinated.
But vaccine hesitancy is not simply an issue for racialized groups, with one study noting that among participants from 149 countries, "there is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues". A separate study published in Nature Medicine in October found that while 72 per cent of people surveyed from 19 countries, said they would be immunized, 14 per cent would refuse and another 14 per cent would hesitate. That study also noted that people with little faith in their governments, even those who’d been infected with COVID-19 in the past, were less likely to get vaccinated for it.
When it comes to confidence in vaccines, everyone falls on a scale, with anti-vax sentiment on one end and being completely accepting of science on the other, says Gordon Thane, a health promotion specialist and member of an educational organization called The Public Health Insight.
“Any strategy that we come up with in public health or health care has to factor in (people’s) differences in belief,” he said. But because the data of medical bias against Black patients persists and Indigenous patients are more likely to be stereotyped, racialized groups have reason to be distrustful of Canada's health-care system.
HESITANCY STEMS FROM HISTORICAL RACISM
Experts who spoke to CTVNews.ca stressed that for racialized people on the fence, it is less about them having unscientific anti-vax sentiment but rather a lingering distrust of government institutions with a history of actively treating patients of colour unethically.
For example, in 2013, it was revealed that throughout the 1940s and 1950s, malnourished Indigenous children served as unwitting subjects in nutritional experiments conducted by government bureaucrats. Tactics included withholding vitamin supplements and milk rations, withholding dental care and feeding them enriched flour that wasn’t legally sold elsewhere in Canada.
“And then (researchers) just watched to see what malnourishment would occur,” Dr. Anna Banerji, faculty lead of Indigenous and Refugee Health at the University of Toronto’s Faculty of Medicine, told CTVNews.ca.
During an interview with Your Morning, Sheila North, former grand chief of the Manitoba Keewatinowi Okimakanak in northern Manitoba, alleged that, “back in residential school days, [people], that are now elders, remember being used as guinea pigs or [having] vaccines tested on them when they were children without their permission or their family’s permission.”
In 2018, a class-action lawsuit was filed on behalf of thousands of Indigenous people who alleged they were subjected to medical tests without consent on reserves and in residential schools between the 1930s and 1950s. Research has revealed that government officials tested tuberculosis vaccines on impoverished Indigenous people during the 1930s instead of fixing poor living conditions that spread the disease.
Banerji and Fazel also cited the unethical Tuskegee Syphilis Experiments, which lasted from 1932 to 1972, where researchers from the United States Public Health Service and the Centers for Disease Control and Prevention purposefully didn’t treat Black patients infected with Syphilis -- and only recorded what happened.
“That history of discrimination, that history of being treated unfairly by the government is something that is still in people’s minds,” Fazel said.
THE FIX? HEAR FROM GROUPS DIRECTLY
Thane, who works in the chronic disease department for the Windsor-Essex County Health Unit in Ontario, urged public health officials and medical regulatory bodies to openly acknowledge this trauma during their vaccine outreach instead of blaming people for remaining to be reluctant to get vaccinated.
“The big thing with marginalized populations is they want to feel validated. They want to be told that they’re not crazy for believing in these things,” Thane said, urging officials to “deploy this trauma-informed, culturally-appropriate care.”
He called using this targeted approach “low-hanging fruit.”
Fazel, whose research focuses on health promotion and misinformation, said targeting care means actually going into the communities. “No one can tell you better about (racialized groups) than themselves… they can be the ones to point out the best ways to improve vaccine hesitancy,” he noted.
The health experts suggested that, over the coming months, public health workers:
- conduct focus groups with various racial and culture groups, such as Black, Indigenous, Asian, South Asian, and Latinx groups, to hear their concerns
- hold open question-and-answer sessions,
- provide cultural and language-specific literature,
- have local public health officials show up at virtual events or lectures
- regularly check in with the community and religious leaders, including from the Christian, Muslim, Jewish, Sikh faiths, to name a few.
Banerji, who advises First Nations communities in northern Ontario, said there should be a concerted effort to have trusted figures take the vaccine too -- such as local and regional chiefs, premiers and officials such as Chief Public Health Officer Dr. Theresa Tam.
And she said authorities also need to outline specific incentives. For example, First Nations communities in complete lockdown should be told that the more people take the vaccine, the sooner the community can open up and “get their lives back.”
Getting that message through might not be hard to do, North said: “There are a lot of people that are welcoming (the vaccine) because the virus is proving to be devastating in a lot of our communities.”
VACCINE DISTRIBUTION IN COMMUNITY HUBS
When it comes to where people can get vaccines, Fazel urged officials to figure out a way to set up sites not just in hospitals and larger hubs, but also in smaller community health centres, “because those health-care workers there already have built up trust in the community.” And that getting vaccines from workers who people already know rather than from a stranger, could be more effective.
But this is easier said than done, as many Indigenous communities are located in remote, fly-in-only areas and already have limited access to rapid and COVID-19 testing.
As Canada pledges to give some vaccine prioritization to First Nations communities, North said leaders seemingly pitting groups against each other isn't helpful.
In early December, heavy criticism was levied at Manitoba Premier Brian Pallister when he said, “They are also telling us that they are going to hold back the portion of our vaccine for Manitoba, that they would then allocate to Indigenous and First Nations communities. Manitobans who do not live in northern Indigenous communities would be the least likely to get a vaccine in the country… this hurts Manitobans, to put it mildly.”
North said, “this was race-baiting. it was trying to get Manitobans to fight over vaccines making it seem like we, as Indigenous people, are in an enviable position to be vulnerable and to be marginalized." She added that, “The most vulnerable should be getting it. Indigenous people are not, of course, celebrating this position to be vulnerable.”
THE COST OF IGNORING DISPARITIES
Experts warn that the cost of ignoring disparities means people will continue to be harmed. Many critics said that the death of Joyce Echaquan, an Atikamekw woman who live-streamed a Quebec hospital worker’s racist insults, wasn't an outlier experience.
In B.C., a recent report found widespread anti-Indigenous discrimination in the province’s health-care system, with "hundreds of examples of prejudice and racism" in its health facilities. And in Manitoba, one in 10 daily reported COVID-19 deaths were Indigenous people. And all this discussion takes place five years after the Truth And Reconciliation final report was released, which outlined how unaddressed health disparities was tied to higher overall suicide rates among First Nations communities than the general population, with that rate being even higher still for Inuit youth.
So if officials fail to target their messaging or continue to ignore systemic racism, it will harm real families the way it did Banerji’s.
She said she lost her 14-year-old adopted Inuk son, Nathan, who was depressed because health-care providers were “blinded and could not see his desperation and generational trauma.” So with vaccine rollout, Banerji urges officials to get the right messaging to reach people.
Thane, a Black health professional, said that vaccine hesitancy is everywhere, even within his own family.
“(A female relative) was mentioning that she’s not going to wait in line (to get the vaccine). She doesn’t believe in it,” he said, being careful not to gaslight her and her concerns about the vaccine's safety.
“I sat down and spoke with her and told her about the clinical trials for the vaccines,” Thane said. And his approach seemed to have gotten through. “Can I go around to every single person to have that conversation? Absolutely not. But everyone has a role to play.”